376617197-7-22-2026-20-CC-SSFE-DW8QWM-20260722123209

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376617197
Report Date: 07/22/2026
Date Signed: 07/22/2026 12:32:32 PM

Document Has Been Signed on 07/22/2026 12:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	ELIZONDO GOMEZ, REBECA FAMILY CHILD CARE		FACILITY NUMBER:	376617197
ADMINISTRATOR/ DIRECTOR:	REBECA ELIZONDO GOMEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 583-1628
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92105
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 12	CENSUS: 6	DATE:	07/22/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Rebeca Elizondo Gomez		TIME VISIT/ INSPECTION COMPLETED:	12:40 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On Wednesday, July 22, 2026 at 9:30 A.M., Licensing Program Analyst (LPA) Saray Siqueiros-Frayre conducted an unannounced Annual/Random Inspection and met with Licensee, Rebeca Elizondo Gomez. LPA introduced self, disclosed the purpose of the inspection and was granted facility entry by the Licensee. Present in the home were licensee, Rebeca Elizondo Gomes, licensee’s husband, Arturo Gomez, daughter, Anakaren Gomez, and six (6) daycare children, two (2) of whom were under 24 months of age. The facility is a single story, four (4) bedroom, two (2) bathroom home and was inspected to ensure a safe and healthy environment for the children in care. LPA Saray Siqueiros-Frayre was guided by Licensee to tour the facility. The days and hours of operation are Monday through Friday, 5:30 AM to 7:00 PM and Saturdays, 6:30 AM to 5:00 PM. The following areas are designated for the provision of child care services: Living room, dining room, bedroom #2, bedroom #3, bedroom #4 (playroom), fully fenced backyard and bathroom #1. Off-limit areas include the following: bedroom #1, bathroom #2, kitchen and garage, and are made inaccessible to day care children through the use of a safety gate, door knob covers and door locks. Licensee has toys and materials accessible for children to use while in care. The home has a fully fenced backyard available for outdoor activities at time of inspection. Licensee stated that active supervision is provided to children during all outdoor activities. Licensee stated that there are no bodies of water on the premises and LPA did not observe any bodies of water during the time of this inspection. Licensee stated there are no firearms, dangerous weapons or ammunition in the home. I addition, Licensee has a working cell phone. The fire extinguisher is rated 2-A;10-B-C, which meets requirements and is mounted on the kitchen wall next to the backdoor exit. Smoke and carbon monoxide detectors were tested and verified to be operational and compliant with requirements. Poisons, detergents, cleaning compounds, medications were made inaccessible to children by being placed in off limit areas and cabinet latches.

Tulam Vu
Saray Siqueiros-Frayre
	DATE: 07/22/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 6

California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

Page: 2 of 6

Document Has Been Signed on 07/22/2026 12:32 PM - It Cannot Be Edited

Created By: Saray Siqueiros-Frayre On 07/22/2026 at 11:45 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ELIZONDO GOMEZ, REBECA FAMILY CHILD CARE	FACILITY NUMBER: 376617197
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/22/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on Interview, observation and record review, the licensee did not comply with the section cited above in that two (2) out of two (2) infants in care did not have a safe sleep log available for review, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/31/2026
	Plan of Correction
1 2 3 4	Licensee stated that she has forgot to complete safe sleep log for the two infants in care becaus they do not always take naps. Licensee stated that she will documents infants sleep moving forward and will submit sleep logs to SDCCRO by 07/31/2026, along with a written POC stating she will ensure to document sleep logs for all infants in care.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Tulam Vu
NAME OF LICENSING PROGRAM MANAGER:

	Saray Siqueiros-Frayre
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026

LIC809 (FAS) - (06/04)

Page: 3 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ELIZONDO GOMEZ, REBECA FAMILY CHILD CARE	FACILITY NUMBER: 376617197
	VISIT DATE: 07/22/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Licensee’s Mandated Reporter AB1207 training certification expires on May 17, 2027. Pediatric CPR and First Aid certification are valid through February, 2028. The Licensee was reminded that certification for Mandated Reporter, Pediatric CPR and First Aid trainings must be completed every two years. Immunization records per SB792 were reviewed for accuracy. Required documents were posted during the time of inspection. Licensee and adult residents in the home have received criminal record clearances and exemption.

The licensee owns the home and provided proof of control of property and is available in the facility file.

The Child roster was reviewed and a copy was obtained. The last fire drill was conducted and documented on March 12, 2026. Staff records were reviewed and are determined to be current. Children’s records were reviewed determined to be complete. Daily Sleep Logs were not available for review upon request.

LPA discussed the facility emergency disaster plan, LIC 311D form and safety of children. The Licensee was hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulations, post all required forms, corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer.

LPA advised that prior to making alterations or additions to the home or grounds including installation of inground or above ground bodies of water, the Licensee shall notify the Department of the proposed change. Licensee stated that they will comply with all regulations and laws governing family child care homes.

A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances and exemptions.

Licensee, Rebecca Elizondo Gomez, was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

NAME OF LICENSING PROGRAM MANAGER: Tulam Vu
NAME OF LICENSING PROGRAM ANALYST: Saray Siqueiros-Frayre
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/22/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026

LIC809 (FAS) - (06/04)

Page: 4 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ELIZONDO GOMEZ, REBECA FAMILY CHILD CARE	FACILITY NUMBER: 376617197
	VISIT DATE: 07/22/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for and removing any recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, Rebeca Elizondo Gomez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Please visit the Guardian web page and set-up your Guardian account. https://cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian. If you have any questions regarding Guardian, please contact CDSS at email: guardian@dss.ca.gov

NAME OF LICENSING PROGRAM MANAGER: Tulam Vu
NAME OF LICENSING PROGRAM ANALYST: Saray Siqueiros-Frayre
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/22/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026

LIC809 (FAS) - (06/04)

Page: 5 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ELIZONDO GOMEZ, REBECA FAMILY CHILD CARE	FACILITY NUMBER: 376617197
	VISIT DATE: 07/22/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

California Code of Regulations, (Title 22, Division 12 & Chapter 3), a Type B deficiency is being cited on the attached LIC 809-D.

A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with the licensee, Rebeca Elizondo Gomez.

NAME OF LICENSING PROGRAM MANAGER: Tulam Vu
NAME OF LICENSING PROGRAM ANALYST: Saray Siqueiros-Frayre
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/22/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026

LIC809 (FAS) - (06/04)

Page: 6 of 6